Shortness of Breath / Desaturation 🫁

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🧠 Definition

  • Shortness of breath or desaturation may reflect underlying respiratory, cardiac, or neurological causes.
  • Assess rapidly and escalate early if the patient appears unwell or is deteriorating.

📞 What to Ask / Orders to Make

  • Is this new or chronic? Any change from baseline?
  • Is the patient alert or confused?
  • PMHx: COPD, heart failure, asthma, previous PE/DVT, malignancy.
  • Recent infection, aspiration risk, recent surgery, or opioid use?
  • Ask nurse to check vitals, administer oxygen, obtain ECG and ABG, prepare for portable CXR.

📋 Common Causes

  • Pneumonia (including aspiration)
  • Pulmonary embolism (PE)
  • Pneumothorax (PTX)
  • Acute pulmonary oedema / heart failure
  • COPD or asthma exacerbation
  • Opiate-induced respiratory depression
  • Acute coronary syndrome (ACS)

🧾 History

  • Timing and onset (sudden vs gradual), orthopnoea, fever, cough, pleuritic chest pain, leg swelling.
  • Risk factors: recent surgery, malignancy, smoking, immobility, known lung or heart disease.

🩺 Examination

  • Vital signs: RR, O₂ saturations, heart rate, blood pressure, GCS.
  • Look for use of accessory muscles, tracheal deviation, cyanosis.
  • Chest exam: auscultate for crackles, wheeze, decreased air entry.
  • Check for raised JVP, peripheral oedema, or signs of DVT.

🔍 Investigations

  • ABG if altered mental status, hypoxia, or underlying COPD.
  • 12-lead ECG to assess for cardiac ischemia, arrhythmias, PE signs (e.g. S1Q3T3).
  • Portable CXR to evaluate for consolidation, oedema, pneumothorax.
  • CTPA if PE is suspected and renal function allows contrast (consider Wells score first).
  • Bloods: FBC, U&E, CRP, troponin, D-dimer, BNP (if heart failure suspected), LFTs.
  • Consider COVID swab, sputum and blood cultures if infection suspected.

💊 Initial Management

  • Position patient upright. Give oxygen to maintain sats 92–96% (or 88–92% in CO₂ retainers).
  • If pulmonary oedema suspected: IV furosemide, GTN if SBP >100 mmHg, consider CPAP.
  • If PE likely: anticoagulate with LMWH or DOAC if no contraindications.
  • If COPD/asthma exacerbation: salbutamol + ipratropium nebulisers, corticosteroids, consider NIV if hypercapnic.
  • If pneumonia suspected: start empirical antibiotics, give fluids and oxygen as needed.
  • Avoid sedatives and opioids unless for palliative management in respiratory failure.

⚠️ When to Escalate

  • Worsening hypoxia or increasing respiratory rate.
  • Decline in GCS or new confusion.
  • Suspected PE, ACS, or pneumothorax.
  • Lack of response to initial treatment or clinical deterioration.

Note Template

Ready-to-use clinical note structure

🕒 20 / 11 / 2025 — 22:39

ATRP re: SOB / ↓ O₂ sats
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [COPD / asthma / heart failure / cancer / other]

🧾 Hx:
• Onset: [sudden / gradual]  • Orthopnoea / cough / pain?
• Recent infection / aspiration / immobility
• Opiates or sedation?

🩺 Exam:
• RR: __  SpO₂: __%  GCS: __  HR: __  BP: __  Temp: __
• Chest: [AE ↓ / crackles / wheeze]
• JVP / oedema / DVT signs

📋 Impression:
Likely cause: [pneumonia / PE / fluid overload / COPD / ACS]

📌 Plan:
• Sit up, O₂ (target sats 92–95% or 88–92% if CO₂ retainer)
• ABG, ECG, CXR, bloods
• Treat cause (abx, furosemide, LMWH, nebs)
• Escalate if unwell or deteriorating

👤 [Your Name], [Role]
IMC: _______
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